Veteran Inquiry | Wigs Plus Vets

First name

Last name

Today's Date

Month

Day

Year

Last 4 of your social security

Phone

Birthday

Month

Day

Year

Email

Which VA Hospital or City/State

Doctor's Name

Do you have an upcoming VA appointment?

Yes

No

Do you use My HealtheVet?

Yes

No

Not Sure

My HealtheVet is the VA's online patient portal where you can message your doctor, view appointments, and request referrals. If you have an account, you can request your cranial prosthesis consult directly through the portal. Visit https://www.myhealth.va.gov to sign up or sign in.

Notes

I authorize Wigs Plus Vets to collect and use my personal

information, including the last four digits of my Social Security

Number, to help me access my VA cranial prosthesis benefit.

I understand this information will be shared only with VA

Prosthetics staff as needed to process my request.

I agree to receive text messages from Wigs Plus regarding my inquiry. Message & data rates may apply. Reply STOP to opt out.

I agree to receive email updates and information from Wigs Plus. I can unsubscribe at any time.

Wigs Plus Vets - Inquiry